Thursday, April 1, 1999 Published at 08:01 GMT 09:01 UKHealthNHS reforms take effectFundholding will be scrapped and GPs will form care groupsFundamental reforms of how the NHS is structured come into effect on Thursday.

GP fundholding - where individual practices run their own budgets - are to be scrapped and replaced with primary care groups.

These will be made up of 50 to 60 GPs, who will eventually become responsible for the whole of their area's health care budget.

The government says this will bring an end to the "two-tier" system of health care, whereby patients from fundholding practices could jump hospital waiting list queues if their doctor was willing to pay.

"Instead of a swathe of bureaucracy, the number of bodies in primary care commissioning care will be slashed from over 3,300 to under 500."

In Wales there will be equivalent Local Health Groups and Scotland will have a different system of Local Health Care Co-operatives.

Doctors have given the scheme a cautious welcome, but fear they will have to take responsibility for local rationing decisions.

In the past, health authorities would make such decisions.

Time scale for implementation

Doctors have also complained about the short time scale for implementing the reforms, which were announced 14 months ago.

Dr John Chisholm is chairman of the British Medical Association's GPs Committee.

He said: "There have been inadequacies in funding, in pay arrangements for the PCG board members, in investment in the new information systems that will be required for strategic planning and clinical governance and inadequacies in organisational development."

Shadow Health Secretary Ann Widdecombe said: "The dragooning of family doctors into unpopular, centralised Primary Care Groups will reduce GPs abilities to concentrate on treating their patients as they have to cope with increased bureaucracy and administration.

"These unpopular collectives will cost around £50m per year - money which will be spent not on clinical services but on bureaucracy and administration.

"Doctors, nurses and patients alike have demonstrated considerable concern at this dramatic change which could have potentially disastrous consequences for primary care in Britain."